title: Exploration of pathways related to the decline in female circumcision in Egypt.
abstract: BACKGROUND
  There has been a large decline in female genital circumcision (FGC) in Egypt in recent decades. Understanding how this change has occurred so rapidly has been an area of particular interest to policymakers and public health officials alike who seek to further discourage the practice elsewhere.
  
  
  METHODS
  We document the trends in this decline in the newest cohorts of young girls and explore the influences of three pathways--socioeconomic development, social media messages, and women's empowerment--for explaining the observed trends. Using the 2005 and 2008 Egypt Demographic and Health Surveys, we estimate several logistic regression models to (1) examine individual and household determinants of circumcision, (2) assess the contributions of different pathways through which these changes may have occurred, and (3) assess the robustness of different pathways when unobserved community differences are taken into account.
  
  
  RESULTS
  Across all communities, socioeconomic status, social media messages, and women's empowerment all have significant independent effects on the risk of circumcision. However, after accounting for unobserved differences across communities, only mother's education and household wealth significantly predict circumcision outcomes. Additional analyses of maternal education suggest that increases in women's education may be causally related to the reduction in FGC prevalence.
  
  
  CONCLUSIONS
  Women's empowerment and social media appear to be more important in explaining differences across communities; within communities, socioeconomic status is a key driver of girls' circumcision risk. Further investigation of community-level women's educational attainment for mothers suggests that investments made in female education a generation ago may have had echo effects on girls' FGC risk a generation later.
authors.affiliation: General Medical Disciplines, Stanford University School of Medicine, Palo Alto, CA, USA. smodrek@stanford.edu.
authors.forename: Sepideh
authors.initials: S
authors.lastname: Modrek
authors.forename: Jenny X
authors.initials: JX
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D019093:Circumcision, Female / Q000639:trends*; D004534:Egypt; D005260:Female; D006306:Health Surveys; D006801:Humans; D008875:Middle Aged; D011209:Power, Psychological; D061108:Social Media; D012959:Socioeconomic Factors; D014930:Women / Q000523:psychology*; D055815:Young Adult